Spiritual care in neonatology: analysis of emergency baptisms in an Irish neonatal unit over 15 years.

BACKGROUND: Emergency baptism remains an important emotional and spiritual element for many parents of critically ill infants in the neonatal unit. There is no published data available as to which neonates are baptised and their outcomes. OBJECTIVES: To evaluate trends, outcomes and characteristics of newborn infants baptised over a 15-year period in an Irish maternity hospital. METHODS: Retrospective study of infants baptised in University Maternity Hospital Limerick (UMHL) over a 15-year period. Patients were identified from the 'register of baptisms' for the years 2002-2016. RESULTS: A total of 354 neonates were identified and further information was available for 341. We observed a gradual decline of emergency baptisms over the 15-year period. A total of 114 (32.2%) infants were term and 199 (56.2%) preterm. A total of 288 infants (81.5%) were baptised by Catholic priest, 61 (17.3%) by staff member, 1 (0.3%) by family member and in 3 cases (0.9%) the person baptising was unrecorded. Day of baptism varied from 1 to 88 with a mean age of 4.6 days. A total of 113 (31.9%) neonates died after baptism. Majority of infants baptised were preterm and low birth weight, with predominance of extremely low birth weight (ELBW) who also had proportionately higher mortality 47 (47.5%) following the baptism. CONCLUSION: Emergency baptism remains an important element in the spiritual care of the critically ill newborn infants and their families. Maternity hospitals and neonatal units should have access to emergency baptism service or other equivalent 'spiritual blessings' as appropriate to the faiths followed by the family, especially in an emerging multi-faith population.

Development of a lecithotrophic pilidium larva illustrates convergent evolution of trochophore-like morphology.

BACKGROUND: The pilidium larva is an idiosyncrasy defining one clade of marine invertebrates, the Pilidiophora (Nemertea, Spiralia). Uniquely, in pilidial development, the juvenile worm forms from a series of isolated rudiments called imaginal discs, then erupts through and devours the larval body during catastrophic metamorphosis. A typical pilidium is planktotrophic and looks like a hat with earflaps, but pilidial diversity is much broader and includes several types of non-feeding pilidia. One of the most intriguing recently discovered types is the lecithotrophic pilidium nielseni of an undescribed species, Micrura sp. "dark" (Lineidae, Heteronemertea, Pilidiophora). The egg-shaped pilidium nielseni bears two transverse circumferential ciliary bands evoking the prototroch and telotroch of the trochophore larva found in some other spiralian phyla (e.g. annelids), but undergoes catastrophic metamorphosis similar to that of other pilidia. While it is clear that the resemblance to the trochophore is convergent, it is not clear how pilidium nielseni acquired this striking morphological similarity. RESULTS: Here, using light and confocal microscopy, we describe the development of pilidium nielseni from fertilization to metamorphosis, and demonstrate that fundamental aspects of pilidial development are conserved. The juvenile forms via three pairs of imaginal discs and two unpaired rudiments inside a distinct larval epidermis, which is devoured by the juvenile during rapid metamorphosis. Pilidium nielseni even develops transient, reduced lobes and lappets in early stages, re-creating the hat-like appearance of a typical pilidium. Notably, its two transverse ciliary bands can be ontogenetically linked to the primary ciliary band spanning the larval lobes and lappets of the typical planktotrophic pilidium. CONCLUSIONS: Our data shows that the development of pilidium nielseni differs remarkably from that of the trochophore, even though their larval morphology is superficially similar. Pilidium nielseni's morphological and developmental features are best explained by transition from planktotrophy to lecithotrophy in the context of pilidial development, rather than by retention of or reversal to what is often assumed to be the spiralian ancestral larval type - the trochophore. Development of pilidium nielseni is a compelling example of convergent evolution of a trochophore-like body plan within Spiralia.